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State agencies hope to move affected patients to marketplace.
During COVID, the federal government has given extra funding to state Medicaid programs as long as people are not cut from Medicaid during the public health emergency, even if beneficiaries lose eligibility in that period. From February 2020 to September 2021, enrollment in Medicaid and the Children’s Health Insurance Program has surged by 19.1 percent, reaching 84.8 million.
The extra federal funding from the emergency could end as soon as July, and the longer the emergency goes on, the greater the coverage losses will be. Estimates put the losses at 12.9 million if it expires at the end of March, 14.4 million in June, and 15.8 million in September.
CMS and other groups working with payers are trying to ensure the process doesn’t lead to a massive surge in the number of uninsured.
For patients who lose Medicaid, how easy it will be for them to get other coverage will depend on where they live. Many are likely eligible for subsidized coverage on Obamacare plans, and CMS is encouraging flexibility for managed care companies with both marketplace and Medicaid plans to do outreach to help move them onto the exchange. However, there are 33 states that don’t run their own exchanges.
Some states may be in better shape than others; some have been keeping up with their redetermination checks throughout the pandemic but keeping newly ineligible people enrolled in Medicaid because of the federal rules.
Redetermination isn’t the only challenge. While many of those losing Medicaid coverage may be able to transition to Obamacare plans, those plans may no longer be affordable if the premium subsidies that Congress passed last year aren’t extended.
The subsidies, which led to a jump in Affordable Care Act enrollment last year as private coverage became cheaper for millions of people, are currently set to expire at the end of 2022. And the lowest-income enrollees would see the steepest increases in premiums and deductibles.
States and health groups are asking for more time to work through eligibility determinations. The Biden administration has said they will have 14 months once the emergency ends.